Senior Product Manager — Fraud, Waste & Abuse (FWA)

Please Note Before Applying:
CODOXO IS NOT ABLE TO OFFER SPONSORSHIP OR ACCOMMODATE ANY CANDIDATES THAT ARE CURRENTLY BEING SPONSORED NOW OR IN THE FUTURE
Of the $3.8T we spend on healthcare in the United States annually, about a third of it is estimated to be lost due to waste, fraud and abuse. Codoxo is the premier provider of artificial intelligence-driven solutions and services that help healthcare companies and agencies proactively detect and reduce risks from fraud, waste, and abuse and ensure payment integrity. Codoxo helps clients manage costs across network management, clinical care, provider coding and billing, payment integrity, and special investigation units. Our software-as-a service applications are built on our proven Forensic AI Engine, which uses patented AI-based technology to identify problems and suspicious behavior far faster and earlier than traditional techniques.
We are venture backed by some of the top investors in the country, with strong financials, and remain one of the fastest growing healthcare AI companies in the industry.
Position Summary:
We are looking for a Senior Product Manager to own the strategy, roadmap, and execution for our AI-powered FWA detection platform.
This is a high-impact role at the intersection of healthcare domain expertise, AI/ML-powered product innovation, and SaaS product management. You will work directly with Special Investigations Units (SIUs), analysts, clinical reviewers, and payer leadership to deliver a product that helps customers detect emerging fraud schemes faster, investigate more efficiently, and recover more dollars.
Beyond managing today's product, we need a PM who can envision the future of FWA management in an agentic AI world, where AI agents don't just surface alerts but autonomously triage leads, gather evidence, draft case narratives, and collaborate with human investigators on the hardest decisions. You should have a strong point of view on how investigator workflows will fundamentally change over the next 2 to 3 years, and how our platform should lead that transformation rather than react to it.
We recognize that candidates who combine deep FWA domain experience with strong SaaS and ML product management skills are rare.
We're Open To Strong Candidates From Either Direction:

• Domain-first candidates: former SIU investigators, analysts, clinical reviewers, or FWA / payment integrity professionals who have moved into product and are eager to deepen their technical and ML product fluency
• Product-first candidates: experienced B2B SaaS or ML/AI product managers who can ramp quickly on the FWA domain, with a demonstrated track record of learning complex regulated domains and partnering effectively with SMEs
  

What we won't compromise on is curiosity, rigor, and the ability to bridge both worlds over time. You should be excited to spend time shadowing investigators and whiteboarding with data scientists about what an agentic future looks like.
Key Responsibilities:

• Own the product roadmap for the core FWA platform, spanning AI-driven detection, alerting, case management, and investigator workflows
• Shape the agentic AI vision for FWA by defining how autonomous and semi-autonomous agents will transform lead triage, investigation, evidence gathering, and case documentation, and build the roadmap to get there responsibly
• Lead customer discovery with SIU directors, investigators, data analysts, nurse reviewers, and medical directors, going beyond surface-level requests to uncover generalizable workflow needs
• Define product requirements across the FWA lifecycle: lead generation, alert triage, investigation, evidence building, overpayment calculation, provider education, recoupment, and law enforcement referral
• Shape the AI-powered detection and investigation experience, making critical product decisions about model explainability, alert prioritization, automation vs. human judgment, and investigator-in-the-loop (and eventually investigator-on-the-loop) workflows
• Collaborate with engineering and data science teams to deliver high-quality products, providing the domain context they need to build effectively and reasoning about precision/recall trade-offs in detection models
• Partner with FWA SMEs, investigators, and clinical reviewers to validate requirements, test assumptions, and stay ahead of emerging fraud schemes (e.g., telehealth, genetic testing, DME), including schemes that will themselves be powered by generative and agentic AI
• Drive go-to-market readiness working with sales, marketing, and implementation teams on positioning, enablement, and launch
• Make principled trade-off decisions by resisting one-off customization requests in favor of scalable, configurable product solutions that serve the broader FWA market
• Ensure compliance and defensibility by partnering with legal, security, and compliance to uphold HIPAA, audit trail, and evidentiary standards that investigators and law enforcement rely on, including the unique governance challenges agentic systems introduce
  

Qualifications:

• 8+ years of combined professional experience across some mix of Product Management, FWA / payment integrity / claims auditing, healthcare analytics, or SaaS/ML product delivery
• At least 2+ years in a Product Management role at a B2B SaaS or healthcare technology company, with direct ownership of roadmap, backlog, and delivery working alongside engineering teams, OR equivalent experience leading analytics, investigative, or operational teams where you owned the "what to build" decisions with technical partners
• Demonstrated ability to learn complex, regulated domains quickly. You can point to a time you went from novice to credible SME in a specialized area
• Strong understanding of healthcare claims data
• Comfort working with AI/ML-powered products. You can reason about automation vs. human review trade-offs, provide feedback on model outputs, and design workflows where AI and human expertise complement each other. Familiarity with basic statistical concepts (anomaly detection, peer comparisons, precision/recall) is expected
• A forward-looking perspective on generative and agentic AI. You follow the space closely, have opinions on where LLMs and AI agents are heading, and can articulate concretely how they will reshape investigative and case management workflows
• Strong customer discovery and stakeholder management skills. You can lead a conversation with a VP of SIU and a frontline investigator with equal confidence, and translate what you learn into clear product direction
• A bias toward scalable product thinking. When a customer asks for a specific feature, you instinctively ask "what's the underlying need?" and look for the platform-level solution
• Hands-on operational experience in an SIU, FWA analytics team, or payment integrity function. Former investigators, analysts, nurse reviewers, or SIU leads bring invaluable workflow intuition
• Working knowledge of healthcare FWA schemes (upcoding, unbundling, phantom billing, medically unnecessary services, kickbacks) and the end-to-end SIU workflow
• Familiarity with healthcare coding and claims data (ICD-10, CPT/HCPCS, NDC, DRG, modifiers, NCCI edits, LCDs/NCDs)
• Understanding of FWA regulatory frameworks: HIPAA, False Claims Act, Anti-Kickback Statute, NHCAA guidelines, and OIG/CMS/MFCU referral processes
• Understanding of health plan IT ecosystems: claims adjudication platforms, EDI transactions (835/837), and provider data
• Experience shipping AI/ML-powered products where model outputs are reviewed or acted on by human users
• Hands-on experience designing products using LLMs, RAG architectures, or agentic AI frameworks (tool use, multi-step reasoning, autonomous agents)
• Direct partnership with data science or ML engineering teams on model performance, explainability, and feedback loops
• Background in statistics, data science, or analytics, formal or self-taught
• Experience managing products at different lifecycle stages simultaneously (sustaining a mature product while launching new capabilities)
• Track record of turning domain-specific insights into configurable, platform-level product capabilities
• Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk.
  

Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@codoxo.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis.
Benefits For You

• Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)
• Unlimited PTO
• Annual Professional Development stipend
• Annual home office stipend
• 401K Match (after 90 days)
  

We Are An Equal Opportunity Employer:
Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.
We're Open To Strong Candidates From Either Direction:

• Domain-first candidates: former SIU investigators, analysts, clinical reviewers, or FWA / payment integrity professionals who have moved into product and are eager to deepen their technical and ML product fluency
• Product-first candidates: experienced B2B SaaS or ML/AI product managers who can ramp quickly on the FWA domain, with a demonstrated track record of learning complex regulated domains and partnering effectively with SMEs
  

What we won't compromise on is curiosity, rigor, and the ability to bridge both worlds over time. You should be excited to spend time shadowing investigators and whiteboarding with data scientists about what an agentic future looks like.
Key Responsibilities:

• Own the product roadmap for the core FWA platform, spanning AI-driven detection, alerting, case management, and investigator workflows
• Shape the agentic AI vision for FWA by defining how autonomous and semi-autonomous agents will transform lead triage, investigation, evidence gathering, and case documentation, and build the roadmap to get there responsibly
• Lead customer discovery with SIU directors, investigators, data analysts, nurse reviewers, and medical directors, going beyond surface-level requests to uncover generalizable workflow needs
• Define product requirements across the FWA lifecycle: lead generation, alert triage, investigation, evidence building, overpayment calculation, provider education, recoupment, and law enforcement referral
• Shape the AI-powered detection and investigation experience, making critical product decisions about model explainability, alert prioritization, automation vs. human judgment, and investigator-in-the-loop (and eventually investigator-on-the-loop) workflows
• Collaborate with engineering and data science teams to deliver high-quality products, providing the domain context they need to build effectively and reasoning about precision/recall trade-offs in detection models
• Partner with FWA SMEs, investigators, and clinical reviewers to validate requirements, test assumptions, and stay ahead of emerging fraud schemes (e.g., telehealth, genetic testing, DME), including schemes that will themselves be powered by generative and agentic AI
• Drive go-to-market readiness working with sales, marketing, and implementation teams on positioning, enablement, and launch
• Make principled trade-off decisions by resisting one-off customization requests in favor of scalable, configurable product solutions that serve the broader FWA market
• Ensure compliance and defensibility by partnering with legal, security, and compliance to uphold HIPAA, audit trail, and evidentiary standards that investigators and law enforcement rely on, including the unique governance challenges agentic systems introduce
  

Qualifications:

• 8+ years of combined professional experience across some mix of Product Management, FWA / payment integrity / claims auditing, healthcare analytics, or SaaS/ML product delivery
• At least 2+ years in a Product Management role at a B2B SaaS or healthcare technology company, with direct ownership of roadmap, backlog, and delivery working alongside engineering teams, OR equivalent experience leading analytics, investigative, or operational teams where you owned the "what to build" decisions with technical partners
• Demonstrated ability to learn complex, regulated domains quickly. You can point to a time you went from novice to credible SME in a specialized area
• Strong understanding of healthcare claims data
• Comfort working with AI/ML-powered products. You can reason about automation vs. human review trade-offs, provide feedback on model outputs, and design workflows where AI and human expertise complement each other. Familiarity with basic statistical concepts (anomaly detection, peer comparisons, precision/recall) is expected
• A forward-looking perspective on generative and agentic AI. You follow the space closely, have opinions on where LLMs and AI agents are heading, and can articulate concretely how they will reshape investigative and case management workflows
• Strong customer discovery and stakeholder management skills. You can lead a conversation with a VP of SIU and a frontline investigator with equal confidence, and translate what you learn into clear product direction
• A bias toward scalable product thinking. When a customer asks for a specific feature, you instinctively ask "what's the underlying need?" and look for the platform-level solution
• Hands-on operational experience in an SIU, FWA analytics team, or payment integrity function. Former investigators, analysts, nurse reviewers, or SIU leads bring invaluable workflow intuition
• Working knowledge of healthcare FWA schemes (upcoding, unbundling, phantom billing, medically unnecessary services, kickbacks) and the end-to-end SIU workflow
• Familiarity with healthcare coding and claims data (ICD-10, CPT/HCPCS, NDC, DRG, modifiers, NCCI edits, LCDs/NCDs)
• Understanding of FWA regulatory frameworks: HIPAA, False Claims Act, Anti-Kickback Statute, NHCAA guidelines, and OIG/CMS/MFCU referral processes
• Understanding of health plan IT ecosystems: claims adjudication platforms, EDI transactions (835/837), and provider data
• Experience shipping AI/ML-powered products where model outputs are reviewed or acted on by human users
• Hands-on experience designing products using LLMs, RAG architectures, or agentic AI frameworks (tool use, multi-step reasoning, autonomous agents)
• Direct partnership with data science or ML engineering teams on model performance, explainability, and feedback loops
• Background in statistics, data science, or analytics, formal or self-taught
• Experience managing products at different lifecycle stages simultaneously (sustaining a mature product while launching new capabilities)
• Track record of turning domain-specific insights into configurable, platform-level product capabilities
• Physical Requirements: Work is performed in an office environment (either in our office or work-from home) and requires the ability to work on a computer, operate standard office equipment, and work at a desk.
  

Accessibility Notice: If you need reasonable accommodation for any part of the employment process due to a physical or mental disability, please send an email to careers@codoxo.com with the subject "Accommodation". Reasonable accommodation requests will be considered on a case-by-case basis.
Benefits For You

• Health, Dental, and Vision insurance with 100% employee premium coverage (Starts Day 1)
• Unlimited PTO
• Annual Professional Development stipend
• Annual home office stipend
• 401K Match (after 90 days)
  

We Are An Equal Opportunity Employer:
Codoxo provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment.
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